Influence of a multidisciplinary protocol on nutritional status at diagnosis in amyotrophic lateral sclerosis

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2018-04, Vol.48, p.67-72
• Main Authors: López-Gómez, Juan José, Torres-Torres, Beatriz, Gómez-Hoyos, Emilia, Fernández-Buey, Nieves, Ortolá-Buigues, Ana, Castro-Lozano, Ángeles, Arenillas-Lara, Juan F., De Luis-Román, Daniel A.
• Format: Article
• Language: English
• Subjects: Amyotrophic lateral sclerosis; Anthropometry; Body mass index; Confidence intervals; Delay; Diagnostic systems; Disease; Dysphagia; Endocrinology; Hospitals; Malnutrition; Medical diagnosis; Medical prognosis; Multidisciplinary assistance; Neurodegenerative disease; Nutrition; Nutritional; Nutritional risk; Nutritional status; Nutritional support; Ostomy; Patients; Quality of life; Remission
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2017.11.010

•Amyotrophic lateral sclerosis (ALS) was associated with weight loss at the beginning of nutritional support of >10% from usual weight.•Early initiation of a multidiscliplinary protocol can result in malnutrition being controlled sooner (2 [1–6] months since diagnosis versus 12 [10–29] months in patients out of the protocol).•A multidisciplinary protocol is an independent protective factor for severe malnutrition in patients with ALS (odds ratio, 0.20; 95% confidence interval, 0.03–0.73). The aim of this study were to understand the influence of a multidisciplinary care protocol in amyotrophic lateral sclerosis (ALS) on the change in the delay of remission to the nutrition specialist and the initial nutritional status. A cohort study was performed in 43 patients with ALS who were referred to the Nutrition Unit between April 2015 and April 2017. Anthropometric parameters and diagnostic times were collected, and the nutritional status was studied through subjective global assessment (SGA). Patients who were included before (control cohort [NoP]) and after (protocol cohort [P]) a multidisciplinary protocol were compared. The mean age of the participants was 66.79 y (10.86 y). Of the patients, 62.8% belonged to the protocol cohort. Patients who started the protocol had a lower delay in initial assessment by a nutrition specialist (P:2 [1–6] mo/NoP:12 [10–29] mo; P = 0.03). When the nutritional status was analyzed according to the SGA, more patients who did not initiate protocol were in the state of severe malnutrition (C) (P 22.2% versus NoP 60%; P = 0.01). Entry into the protocol was an independent protective factor of the presence of severe malnutrition at the beginning of the nutritional follow-up (odds ratio, 0.20; 95% confidence interval, 0.03–0.73; P = 0.02). The implementation of a multidisciplinary protocol in ALS allowed patients to present a lower percentage of severe malnutrition in an initial assessment by the nutrition specialist. This protocol is a protective factor for the presence of malnutrition at the beginning of support.